Herzschrittmachertherapie und Elektrophysiologie最新文献

{"title":"[Vascular closure following electrophysiological procedures-a practical guide].","authors":"Christian-Hendrik Heeger, Henning Rolfes","doi":"10.1007/s00399-025-01108-3","DOIUrl":"https://doi.org/10.1007/s00399-025-01108-3","url":null,"abstract":"<p><p>The proposed introduction of outpatient electrophysiological procedures challenges physicians with the task of safely discharging patients after only a few hours of monitoring. Despite the widely established use of ultrasound-guided vascular access in many centers, access-site complications remain the most common complications associated with electrophysiological interventions. Modern vascular closure devices have made postprocedural care safer and more comfortable. Nevertheless, the traditional Z‑suture continues to play an important role, particularly in cases of individual anatomical challenges or as a fallback option in the event of device failure. The choice of the closure method should always be made on an individual basis, taking into account vascular access, patient safety, available resources, and physician expertise. This review article focuses on techniques and systems for the periprocedural management of vascular access in electrophysiology.</p>","PeriodicalId":52403,"journal":{"name":"Herzschrittmachertherapie und Elektrophysiologie","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145233968","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Electrocardioversion of atrial fibrillation: executive summary of the German Cardiac Society position paper].","authors":"Jakob Lüker, Dirk Vollmann, Leon Iden, Henning Jansen, Laura Rottner, Harilaos Bogossian, Christian Perings, Ralf Birkemeyer, Lars Eckardt","doi":"10.1007/s00399-025-01109-2","DOIUrl":"https://doi.org/10.1007/s00399-025-01109-2","url":null,"abstract":"<p><p>Electrical cardioversion (ECV) is an established and effective method for restoring sinus rhythm in patients with persistent atrial fibrillation. A position paper by the German Cardiac Society provides practical, evidence-based recommendations to guide clinical implementation of ECV and is summarized here. Key topics include appropriate patient selection, pre- and postprocedural management, anticoagulation strategies, sedation protocols, and technical considerations (such as electrode placement and energy levels). The document emphasizes the role of ECV as part of a broader rhythm control strategy. This paper aims to standardize and improve quality of care by translating current scientific knowledge and expert consensus into clear, practical clinical guidance.</p>","PeriodicalId":52403,"journal":{"name":"Herzschrittmachertherapie und Elektrophysiologie","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145193969","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Comment on the European Society of Cardiology (ESC) Clinical Consensus Statement on the indication for conduction system pacing].","authors":"Carsten W Israel","doi":"10.1007/s00399-025-01106-5","DOIUrl":"https://doi.org/10.1007/s00399-025-01106-5","url":null,"abstract":"<p><p>The Clinical Consensus Statement of the European Society of Cardiology (ESC) updates expert opinions on conduction system pacing (CSP). It does not represent a focused update of the ESC pacemaker guidelines of 2021 since that would require the publication of new results of randomized trials. But an official statement became necessary because at the time of preparing the ESC guidelines on pacing and cardiac resynchronization, only very limited data on left bundle branch pacing were available rendering this form of pacing almost completely ignored in the recommendations. Second, daily implantation practice has changed substantially worldwide since the advent of CSP. Third, basically all international heart rhythm societies apart from the ESC have published new guidelines on the use CSP in 2023 which differ significantly from the European recommendations. The Clinical Consensus Statement on CSP of the ESC differs from the 2021 ESC guidelines only in nuances since ESC statutes do not allow that an ESC expert opinion paper substantially contradict current ESC guidelines. However, it is important for daily practice that CSP be recommended as a potential alternative to right ventricular pacing in patients with good left ventricular function or rare ventricular pacing is expected. Similarly, CSP is recommended as an alternative to biventricular pacing (BiVP) in reduced left ventricular function, in context with ablation of the atrioventricular node, in heart failure with wide QRS complex and for upgrading in pacing-induced cardiomyopathy. Finally, CSP is recommended in nonresponders to BiVP.</p>","PeriodicalId":52403,"journal":{"name":"Herzschrittmachertherapie und Elektrophysiologie","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145114748","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Modern WPW-syndrome treatment: from ECG via double-check-mapping to ablation].","authors":"Harilaos Bogossian, Nana-Yaw Bimpong-Buta, Sebastian Robl, Konstantinos Iliodromitis","doi":"10.1007/s00399-025-01093-7","DOIUrl":"10.1007/s00399-025-01093-7","url":null,"abstract":"","PeriodicalId":52403,"journal":{"name":"Herzschrittmachertherapie und Elektrophysiologie","volume":" ","pages":"245-248"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144700333","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Management of channelopathies in children.","authors":"Ulrich Krause","doi":"10.1007/s00399-025-01098-2","DOIUrl":"10.1007/s00399-025-01098-2","url":null,"abstract":"<p><p>Cardiac channelopathies are a group of hereditary diseases that expose affected children and adolescents to an increased risk of syncope and sudden cardiac death (SCD) due to malignant ventricular tachyarrhythmias. Although cardiac channelopathies are rare, with an estimated prevalence of 1:2000-1:10,000, early recognition in order to start treatment and prevent SCD is warranted. The following article provides an overview of current recommendations and facts on the diagnosis and treatment of cardiac channelopathies in children and adolescents. The most commonly encountered cardiac channelopathies during childhood and adolescence include long QT syndrome (LQTS), catecholaminergic polymorphic ventricular tachycardia (CPVT), Brugada syndrome (BrS) and short QT syndrome (SQTS). While subjects with LQTS and CPVT commonly respond well to β‑blocker medication, and flecainide is an additional option in patients with CPVT, no such highly effective drug therapy exists for the treatment of patients with BrS or SQTS. Left cardiac sympathetic denervation is an additional treatment option in subjects with LQTS or CPVT. Implantable cardioverter-defibrillator implantation is indicated in patients with channelopathies and life-threatening ventricular tachyarrhythmias despite adequate antiarrhythmic medication.</p>","PeriodicalId":52403,"journal":{"name":"Herzschrittmachertherapie und Elektrophysiologie","volume":" ","pages":"186-191"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144785895","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Role and practical aspects of antiarrhythmic therapy in acute and chronic settings in children.","authors":"Roman Gebauer","doi":"10.1007/s00399-025-01097-3","DOIUrl":"10.1007/s00399-025-01097-3","url":null,"abstract":"<p><strong>Background and aim: </strong>Cardiac arrhythmias in children require early diagnosis and individualised treatment approaches that differ significantly from those used in adult medicine. This article reviews the role of antiarrhythmic drugs in acute and chronic clinical situations in children, focusing on practical use, safety and integration of non-pharmacological measures.</p><p><strong>Results: </strong>Adenosine is the drug of choice for the acute treatment of supraventricular tachycardia. The aim of chronic drug prophylaxis is to achieve freedom from recurrence until the arrhythmia resolves spontaneously (more common in young children) or until elective catheter ablation is performed as a causal treatment for the arrhythmia. Several classes of antiarrhythmic drugs are used in long-term treatment. Amiodarone is usually reserved for complicated, treatment-resistant cases. When choosing a beta-blocker, the history of asthmatic-like symptoms in children should be taken into account and cardioselective beta-blockers should be chosen.</p><p><strong>Discussion: </strong>Antiarrhythmic drugs are an essential part of the management of arrhythmias in children. Weight-adjusted dosing, close monitoring and age-appropriate use ensure safe and effective therapy. Multidisciplinary care and individualised strategies are essential for successful treatment.</p>","PeriodicalId":52403,"journal":{"name":"Herzschrittmachertherapie und Elektrophysiologie","volume":" ","pages":"192-196"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144800890","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Catheter ablation of tachyarrhythmias in children: state of the art and future directions.","authors":"Ferran Roses-Noguer, Joachim Hebe","doi":"10.1007/s00399-025-01102-9","DOIUrl":"10.1007/s00399-025-01102-9","url":null,"abstract":"<p><strong>Introduction: </strong>Paediatric catheter ablation procedures have traditionally relied heavily on fluoroscopic guidance, exposing children to ionizing radiation and the associated long-term cancer risks ranging from 0.4 to 6.0% of total lifetime cancer risk. This necessitates technological innovations to minimize radiation dependency while maintaining therapeutic effectiveness.</p><p><strong>Objectives: </strong>To review current state-of-the-art technologies and emerging innovations in paediatric catheter ablation.</p><p><strong>Materials and methods: </strong>This review examines advanced three-dimensional (3D) mapping algorithms, including low voltage bridge mapping, late annotation electrograms, open window mapping, and omnipolar technology for substrate characterization. Intracardiac echocardiography and digital twin frameworks utilizing cardiac magnetic resonance imaging, computed tomography, and electrocardiogram data for personalized procedural planning are also analyzed.</p><p><strong>Results: </strong>The implementation of advanced 3D mapping systems demonstrates a marked reduction in radiation exposure while optimizing procedural outcomes across structurally normal and complex congenital heart disease patients. Intracardiac echocardiography provides high-resolution real-time imaging, eliminating fluoroscopic dependence and enabling dynamic clinical decision-making during complex procedures. Focal pulsed field ablation may have a role in paediatric ablations, as it potentially reduces the risk of damaging the conduction tissue and other nearby structures.</p><p><strong>Conclusions: </strong>The integration of advanced imaging technologies represents transformative progress in paediatric electrophysiology, enabling safer, more precise interventions with significantly reduced radiation exposure. These innovations establish new paradigms for personalized paediatric cardiac care, promising improved long-term outcomes for vulnerable populations requiring catheter ablation procedures.</p>","PeriodicalId":52403,"journal":{"name":"Herzschrittmachertherapie und Elektrophysiologie","volume":" ","pages":"197-205"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12457477/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145066213","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Coronary heart disease-a German paradox : Using AI-based technology to solve a relevant healthcare problem].","authors":"B A Remppis, M J Zellweger, S Kelle, A Leber, M Weißer, P V Heinl, L S Freudenberg, C Rischpler, T Emrich, P Mildenberger, T Helms","doi":"10.1007/s00399-025-01094-6","DOIUrl":"https://doi.org/10.1007/s00399-025-01094-6","url":null,"abstract":"<p><p>The German healthcare system is facing challenges in diagnosing coronary artery disease (CAD). These include high mortality rates, even when advanced medical technology is used, and an excessive number of coronary angiographies. A key issue is that current guideline models inaccurately estimate pretest probability (PTP). However, accurately determining PTP is crucial for efficiently guiding the diagnostic pathway and ensuring cost-effectiveness. Artificial intelligence (AI)-based systems offer a solution for precisely determining a personalized PTP. Approved medical AI devices calculate a personalized PTP using laboratory values and medical history. These systems achieve high accuracy (area under the curve 0.87), improve patient selection, avoid unnecessary diagnostics for low-risk patients, and demonstrate significant cost savings. AI-based PTP is essential for improving guideline-based CAD diagnostics and utilizing resources more efficiently.</p>","PeriodicalId":52403,"journal":{"name":"Herzschrittmachertherapie und Elektrophysiologie","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144978255","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Erratum zu: Leitfaden zur sicheren und effektiven Vorhofflimmerablation mit Pulsed Field Ablation am Beispiel des pentaspline PFA-System.","authors":"Nico Reinsch, Victoria Johnson, Sascha Rolf, Sonia Busch, Micaela Ebert, Tilmann Maurer, Roland Tilz, Till Althoff, Julian Chun, David Duncker, Christian Heeger, Henning Jansen, Leon Iden, Andreas Rillig, Philipp Sommer, Tillman Dahme, Melanie Gunawardene, Heidi L Estner, Daniel Steven","doi":"10.1007/s00399-025-01087-5","DOIUrl":"10.1007/s00399-025-01087-5","url":null,"abstract":"","PeriodicalId":52403,"journal":{"name":"Herzschrittmachertherapie und Elektrophysiologie","volume":" ","pages":"275-276"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12457519/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144327732","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Electrical device therapy in the paediatric population-age, indications, strategies and limitations.","authors":"Massimo Stefano Silvetti","doi":"10.1007/s00399-025-01091-9","DOIUrl":"10.1007/s00399-025-01091-9","url":null,"abstract":"<p><strong>Background: </strong>Electrical device therapy is increasingly used for paediatric patients with congenital and acquired arrhythmias and heart diseases.</p><p><strong>Objectives: </strong>This review evaluates the indications, strategies and limitations of this therapy in the young. Pacing and defibrillation systems in young patients should last longer than in adults. The paediatric population ranges from preterm newborns to young adults, and therefore recommendations and pacing strategies are variable. Recent guidelines have provided new and updated recommendations. Various systems have enhanced our ability to treat arrhythmias. Transvenous and epicardial pacing systems compete for primacy among children; transvenous and subcutaneous defibrillators among adolescents. Outcomes are good, but there are frequent complications.</p><p><strong>Conclusion: </strong>Electrical device therapy in the paediatric population is effective and safe, but it needs to be adapted to the age, size, and pathophysiology patients.</p>","PeriodicalId":52403,"journal":{"name":"Herzschrittmachertherapie und Elektrophysiologie","volume":" ","pages":"206-210"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144735257","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}